6b. Endocrine Health - Diabetes Flashcards
What are GLUT proteins?
Facilitate transport of glucose
What does GLUT1 do?
Basal glucose uptake without insulin
What does GLUT2 do?
Mediates glycolysis and gluconeogenesis
What does GLUT4 do?
Glucose uptake with insulin
Can increase glucose uptake 20-30 fold
What is diabetes mellitus?
Group of metabolic disorders with persistent hyperglycaemia caused by deficient insulin secretion, resistance to insulin or both
What is T1D?
AI
Absolute insulin deficiency
What is T2D?
Insulin resistance (with/without)
Relative insulin deficiency
What is pre-diabetes?
Hyperglycaemia
Increased risk of T2D and metabolic syndrome
What is gestational diabetes?
Develops during pregnancy
Normally resolves
What is a normal reading for fasting blood glucose?
Below 5.5 nmol/L
What is a pre-diabetic reading for fasting blood glucose?
5.5 - 6.9 nmol/L
What is a diabetes reading for fasting blood glucose?
> 7.0 nmol/L
What is a normal reading for an HbA1c test?
Below 42 mmol/mol
What is a pre-diabetic reading for an HbA1c test?
42 - 47 mmol/mol
What is a diabetic reading for an HbA1c test?
> 48 mmol/mol
Signs/symptoms of T2D
Increased urination
Excessive thirst
Excessive hunger
Extreme fatigue
Obesity
Acanthosis nigricans
Blurry vision
Poor wound healing
Recurrent infections
Complications of T2D
CVD
Hypertension
Stroke
Elevated homocysteine
Retinopathy
Peripheral neuropathy
AZD
Causes/risk factors of T2D
Family history
Ethnicity - Asian, African, Afro-Caribbean
Advancing age
Diet - high GL, alcohol, high saturated fat, low fibre, low AO
Nutrient deficiencies - C, E, B3, B5, B6, Mg, Cr, Zn, O3
Obesity
Reduced physical activity
High oxidative stress
Chronic stress
Mitochondria dysfunction - increased ROS, decreased GLUT4
Poor methylation - high homocysteine, hypertension, high triglycerides
Pre-diabetes
How is gut dysbiosis implicated in T2D?
Drive inflammatory processes
Modulate SCFA production
Alter intestinal permeability
Cause metabolic endotoxaemia increasing circulating LPS
Which bacteria strains have been found to be protective against T2D?
Bifidobacterium
Faecalibacterium
Akkermansia
Roseburia
Which bacteria strains have been found to increase the risk of T2D?
Ruminococcus
Fusobacterium
Blautia
Generally low diversity overall
Naturopathic approaches to supporting T2D
Low GL meals/low carb diet - control blood glucose/lower IL-6
Increase fibre - slower release of glucose
Increase protein
Avoid refined carbs and snacks
Avoid inflammatory foods
Increase AO foods
Address dysbiosis - Lactobacillus acidphillus
Calorie restriction
Address stress
Sleep hygiene
Nutrients to support T2D
Mg
Zn
B vits
D, C, E
Chromium
EFAs
CoQ10
Alpha lipoic acid
Herbs to support T2D
Panax ginseng
Fenugreek seeds
Onions
Garlic
Cinnamon
Why is chromium important in supporting T2D?
Component of chromodulin, a protein that increases the sensitivity of tyrosine kinase which enhances the glucose uptake from GLUT4 cell receptors
May reduce carb cravings
Examples of chromium rich foods
Eggs
Turkey
Broccoli
Barley
Oats
Supplement dosage of chromium in supporting T2D
200-1000mcg/day
Why is alpha lipoic acid important in supporting T2D?
AO - reducing oxidative stress/inflammation
Improves insulin sensitivity by increasing GLUT4 translocation to cell membranes
Examples of alpha lipoic rich foods
Broccoli
Brussel sprouts
Spinach
Potato
Carrots
Beets
Tomatoes
Peas
Red meat
Supplement dosage of alpha lipoic acid in supporting T2D
200-600mg/day
Why is cinnamon important in supporting T2D?
Enhances insulin sensitivity
Promotes insulin release
Why is Mg important in supporting T2D?
Regulates insulin activity
Modules cell membrane glucose transport
Supplement dosage for Mg in supporting T2D
200-400mg/day
Why is vit D important in supporting T2D?
Insulin sensitivity - activates transcription of insulin gene
Beta cell function
Systemic inflammation
Why is myo-inositol important in supporting T2D?
Reduces blood glucose and insulin levels by improving insulin cell signalling
Supplement dosage for myo-inositol in supporting T2D
Up to 4g/day
Why is biotin important in supporting T2D?
Improve blood glucose control
Increases activity of glucokinase enzyme
Supplement dosage of biotin to support T2D
1-2mg/day
Why are EPA and DHA important in supporting T2D?
Improves insulin sensitivity
Improves GLUT4 glucose transporter translocation into cell membranes
Reduces systemic inflammation
Supplement dosage of EPA/DHA to support T2D
3g/day
Why is Zn important in supporting T2D?
Increased urinary loss due to hyperglycaemia
Regulates insulin receptor responses
Co-factor for AO enzymes
Supplement dosage for Zn in supporting T2D
15-20mg/day
Why is CoQ10 important in supporting T2D?
Deficiency can lead to reduced glucose metabolism and insulin resistance
Cell respiration (ETC)
Supplement dosage of CoQ10 in supporting T2D
100-200mg/day
Why is berberine important in supporting T2D?
Decreases gluconeogenesis
Facilitates GLUT4 translocation
Reduces expression of proinflammatory genes
Modulates microbiome
Increases AMPK activity of islet cells
Why are reishi mushrooms important in supporting T2D?
Gandoderic acids increase insulin secretion and decrease insulin resistance
Why is milk thistle important in supporting T2D?
Reduces fasting glucose
Improves liver function
Protective against NAFLD
In which gender is T1D more common?
Men
How many years can T1D reduce life expectancy by?
11-15
Signs/symptoms of T1D
Similar to T2D but more severe and faster onset
Why can hypoglycaemia occur in T1D?
Missing meals
Over-exercising
Excess anti-diabetic medication
What does T1D increase the risk of?
Other AI diseases - Grave’s, Hashimoto’s, coeliac disease
Causes/risk factors of T1D
Genetics - polymorphisms (HLA-DR/DQ gene)
Stress
Viral infections
Obesity
Early intake of gluten
C-section
Nitrates - smoked/cured meats
Vit D deficiency
O3 deficiency - promotes inflammation
Gut dysbiosis/intestinal permeability
Elevated zonulin
How is T1D monitored at home?
Glucose monitoring devices - Freestylelibre, Dexcom
Naturopathic approaches to supporting T1D
Same as for T2D
Support blood glucose balance
Restore nutrient deficiencies - vit D, O3
Optimise gut health
Reduce stress
Increase exercise
Improve sleep
Reduce inflammation
Remove allergic triggers